The Latest In USB Acoutrements

I hesitate to post this, but I got a good laugh out of it, and you will, too. These adorable little pups plug into any USB port (I think they work equally well with USB 1.0 and 2.0, although perhaps they perform faster with the latter.) Just in case you don't quite yet have the visual of exactly what it is they do, here is a movie clip of the little critters in action. I know I want one. This might be just the advertising gimick for some large companies out there to demonstrate their "loving" attitude toward their customers.

radRounds.com

I received an invitation to join a new social network from its founder, Steven Chan, MD, MS, a private practice radiologist in New York State. The idea was to create a FaceBook- or MySpace-like site to ". . . allow our natural connections with each other with the aid of the internet to foster new collaborations, idea exchange, new ventures, and job opportunities for us radiologists. We restrict membership only to invited industry leaders, radiologists, and rads recruiters (the non annoying ones)." I've personally never met a non-annoying recruiter, but I guess they do exist.



I went to Steve's site, liked what I saw, and signed up. The front page fills in more details of the site's goals:

Welcome to radRounds!

radRounds is a tool for radiologists. It was created by radiologists to help with clinical work and enriching one's career. Some examples of uses might include:

• Finding another radiologist who can help with an MR imaging sequence, job search, or tough case


• Talking privately to an inside-connection about that practice you plan to join


• Establishing a new collaboration to start a multi-center clinical trial


• Leaving radiology and looking for an investment banking job


• Searching for the dream job or hiring the dream candidate / future partner


• Keeping in touch with alumni from your residency program and old friends from the RSNA


• Discussing the latest topics and turf battles of radiology


• Finding out the next time someone gives a lecture/CME on your area of interest


• Starting your own (private or public) group or blog

And, above all, sharing one's interests, expertise, and connections with others. radRounds will most rapidly improve with the help of the people who use it. Spread the word too and invite a fellow radiologist. By the way, suggestions and comments are all strongly encouraged.

OK, I'm spreading the word. radRounds is a site worthy of our participation. I think it will be complementary to several existing radiology sites such as Filmjacket.com, and of course Auntminnie.com. Check it out!

Amicas + Siemens = ???

In response to my RSNA report about Amicas and Siemens, Anonymous asks this question:

Thanks for expressing your analysis on Amicas. I couldn't help but notice Amicas and Siemens in the same sentence. Do you think this would be a good acquisition for Siemens with the recent GE / Dynamic Imaging aquisition?

Interesting thought. The speculation on who will buy whom runs rampant, especially around RSNA time. I'll give you some rudimentary (read: uneducated) analysis about the topic, and follow that with what I hope actually does happen.

With that large company having just acquired the smaller company as mentioned by Anonymous, there aren't too many operations left that need a new PACS, let alone have the resources to afford one. Those that come to mind immediately are Siemens and Cerner. Philips bought Stentor a few years back, Fuji has their own, and Kodak has spun theirs off as CareStream (still sounds more like something the urologists should be dealing with than a PACS.)

Cerner had at one time a solution written by Cedara, now owned by Merge. I looked at it briefly in 2003 and wasn't terribly impressed. Neither were many others, as there were very few ever installed. Today, Cerner's ProVision™ PACS offering (which I didn't bother to look at whilst at RSNA) has these features according to their web site:

The Cerner ProVision™ Workstation is a comprehensive solution for diagnostic softcopy reading of digital images. In order to provide you with increased flexibility, the workstation supports multi-monitor configurations, "set up and save" viewing protocols, global user preferences, and comprehensive MPR features eliminating the need for specialty workstations.

In addition, the Cerner ProVision Workstation allows you to:

• Increase productivity and physician satisfaction with decreased report turnaround
  
• Generate continued returns from legacy investments and compliance to DICOM standards
  
• Provide increased patient safety with synchronization of patient, procedure and image information when configured with Cerner’s RadNet including voice recognition and access to the EMR

Uh, well, nothing really distinguishing there, I'm afraid. Some of our hospitals use Cerner's Millenium RadNet, and since this is a kinder, gentler blog, let me simply say that I really, really like using Empiric's Encompass.net. I'm not sure how Cerner feels about its latest PACS, nor if it is thinking it needs a replacement. But, it pays to keep one's eyes open on such things.

Siemens has had a somewhat irregular history in the PACS field. SIENET Magic PACS came and went, and I don't think anyone would consider it particularly beloved. There was much hype in recent years about SIENET® Cosmos, which was a combined RIS/PACS product using Siemens syngo® common user interface, and e.soft which Siemens in 2000 defined thusly:

"e.soft is the first medical imaging computer that will adapt itself to the way the system's users work--and then do the work for them. . ."

So, syngo is an environment of a sort, that runs under Windows. e.soft is the programming language, although some of the definitions seem to be a little fluid.

Today, Cosmos has evolved into the syngo® Suite. The environment works something like this when integrated with the Siemens Sorian RIS:

It's an interesting concept that attempts to place a common interface on everything from the order entry to the scanner to the PACS. This is a good idea in theory, but most rads don't run the scanner, and most clerks don't read the images. I use the syngo/e.soft system on my Leonardo, I mean syngo workstation on which I read my PET/CT's. It is usable, but more than a little esoteric, and quite frankly, I would find it difficult to use as a PACS. That's my opinion, and I'm sticking to it. Sales of Cosmos/syngo PACS have not been great. I suspect I'm not the only one who can't quite get used to the idea. There are those who think that the Siemens back end is bullet-proof (see this thread), and I won't dispute that per se, but I'm not sure a PACS needs to be bullet-proof in this day and age. Anyway, the bottom line to me is that Siemens really should consider a new PACS. Let the common interface idea go.

Now comes the editorial part of my answer. PACS is one tough business. Many of the small fry are either bought out or go under every year. Anonymous of course cites one of the largest PACS acquisitions, probably followed closely by Philips' buying Stentor to create iSite. As near as I can tell, iSite is doing well under Philips' stewardship. (And Sectra, the "jilted" product, is doing OK itself.) If Cerner or Siemens wanted to buy a company, who is left? I would leave out the much smaller players, such as eRad, and so forth, and make a rather short list of Amicas, Emageon, and Agfa. Yes, Agfa PACS is apparently for sale, as I noted earlier, although it has yet to be sold. I have no idea how many suitors have approached Agfa, but I suspect the number is quite small, as it is probably a very expensive purchase indeed. Emageon has had its troubles, but its stock price has stabilized this month, albeit at a rather low level. The last time I looked at the product, it seemed good, and I'm looking forward to seeing it again in Seattle at SIIM.

And Amicas? Well, that's a different story. Amicas has a lot of cash in the bank, a new product in the works, and a veteran manager, Dr. Steve Kahane, at its helm. If I were giving Siemens (or Cerner) advice, I would say buy it, buy it NOW. Siemens, in my humble opinion, needs a new interface, and Amicas has a really good one. BUT, if I were giving Amicas advice, I would say, "Stay independent!" Being your own company allows a degree of lattitude that prompts development of innovative products. I know the folks at Amicas, and they know what they're doing. Would they survive under a large company? Most likely, as long as they were given a very long leash, but a leash is still a leash, isn't it? This is one of those "if it ain't broke, don't fix it" situations.

I realize that Amicas' stock hasn't done spectacularly well, either, and it just goes to show that the market doesn't understand the PACS business too well. For what it's worth, Amicas is buying back some stock:

"AMICAS chose to repurchase under Rule 10b5-1 because a 10b5-1 plan allows us to focus on the business rather than worry about timing and trading of our stock. This plan also allows us the flexibility to repurchase shares when the company may otherwise be precluded from doing so under insider trading laws," said Stephen Kahane MD, CEO and chairman of AMICAS.

Do the Big Companies do that? I suppose so. But I'm not interested in buying the stock (sorry, Steve), but I am interested in a PACS that works. Would Amicas PACS work as well (and be as affordable) if it were Siemens Vision Series PACS? I can't answer that. But I selfishly hope the status quo continues. It's working for me.

Laziness, Or Something Else?

AuntMinnie user rogens50 asks if radiologists are "cutting our own throats" with laziness?" I've reproduced part of his post below"

This is a big pet peeve of mine. I have a group in which I think there are very good radiologists. However, I am constantly annoyed at reading reports which are basically just descriptive words and seem to make no effort to get down to the nature of the patient's problem or try to make a diagnosis. This problem is not only unique to my group, buy almost every group in which I review studies. Since we are busier and busier these days, many people in the group treat the reading list like the old "Space Invaders" game in which the only purpose it to shoot down as many enemy spaceships (in this case, patients on the PACS reading list) as quickly as possible. I guess I may be too "anal" about this since I was trained in a residency program where my favorite mentors constantly implored me that "nothing makes you smarter than the old films". In the old days, it was a pain to look at many of old studies and reports which were stuffed in the jacket, but now in the PACS era, all of this information is one or two mouse clicks away. I feel it is the radiologist role to give as accurate assessment as possible as to what is going on with the patient as opposed to generate some generic descriptive report. It seems that there is no academic curiosity or underlying desire to provide any real depth of information to the referring physician and thus help the patient. I can give numerous examples.

Rogens then does cite several situations illustrating his point, such as obvious instances when only the most recent chest radiograph (if that) was reviewed in comparison to the current study. He recommends:

In general, I feel you should try to approach the case is it were you or a family member. Certainly, you may not be quite as diligent as if they were your images, but this is at least a mindset you should have. If you read some of these reports and you and your family member had unnecessary procedures or imaging studies as a result of it, you would feel the radiologist is not doing his job.

And what might the consequences be if we continue?

By generating these kinds of reports, we are taking ourselves away from truly helping the patient. At some point clinicians and administrators may say, "If this is the kind of information I am getting, I might as well get cheaper dayhawks or maybe in the future, send them to India" Therefore, are we cutting our own throats by providing trivial readings?

But even rogens50 realizes that this may not be so easy...

I will admit when I am on call and drowning in studies, I reluctantly cut some, but certainly not all corners, but still try to provide as much information as possible. I try to address situations where the radiologists are overloaded with studies (call) at group meetings and try to correct this problem. Sometimes on call, I feel like I am the Lucille Ball character from the clip where she is trying to keep up on the candy production line. . .

I thought everyone would appreciate the video clip above in light of the analogy.

I'm going to assume rogens is fairly fresh from training. That is not meant in a derogatory manner, but just as a point of speculation. As an aside, my group has hired a number of new kids in the past year or so, and their training and work ethic has been phenomenal. I'll bet rogens is at least up to their (very high) level. Now, I'm assuming he is new because his main thesis demonstrates some naivetee. No, not the part about adding diagnostic value to the reports, and reviewing as many pertinent old studies as possible. There, rogens is spot on. This is a necessary part of our interpretations, and must not be neglected.

No, rogens goes astray with the assumption that the problem is laziness. Really, I don't think even he believes this to be the cause, but perhaps it is the first answer that comes to mind. While sloth may be the answer for some of us some of the time, and for a few of us a lot of the time, it is not the real underlying problem. Rather, the sheer volume we face each day is the biggest obstacle to providing the level of service we think optimal. Based on the "Lucy" remark, rogens understands this, too, but he only mentions "drowning in studies" on call. For most of us, that's just the beginning.

Veteran poster MISTRAD puts it best:

Our workload as rads has so dramatically increased over the last decade, I think we are getting close to our maximum capacity to read studies. Sure, you could read more hours, but frankly for me after a 9 hour shift reading 150 or so studies, I am burned out. I agree with all of your points, but I don't know if the solution, other than hiring more people, is easy.

But, hiring more radiologists means diluting the revenue, and that is the last thing most groups will consider. No, more and more of us are trying to replace shrinking reimbursement with even more volume. At some point, that too will fail, as we will indeed max out on how many studies we can read. Not only do we run the risk of issuing a "typical radiologist mumbo-jumbo, non-commital, uncompared" report, but the faster we push through that heavier volume, the more findings we will miss. At some point, the patients' welfare has got to take precedence over our scramble for one last dollar.

So, rogens50, you have a very valid point. We do need to do better in the areas you outline. But I can guarantee you that in the majority of cases, the problem is emphatically not that we are lazy, nor are we playing games to get the work done and get out. We are tired, we are overworked. I won't be so crass as to claim that we are underpaid, however, and that may be the problem. We may well be so concerned about avoiding being underpaid, that we create worse problems.

Lucy, I feel your pain.

Why Medical Care Is So Expensive

Image credit: http://www.about.com

I ran across this patient problem list the other day. This is completely real, but anonymized to protect the innocent:

1. Probable occlusive coronary artery disease but fairly asymptomatic. Patient will return for a Persantine Cardiolite.


2. Systolic murmurs consistent with mitral insufficiency and aortic sclerosis. She will return for an echocardiogram.


3. Labile hypertension. We need to rule out renal artery stenosis. Patient will have a CT angiogram of her renal arteries.


4. Historically occluded left carotid. I do not believe it with a lesion in the right. Patient will have a CT angiogram of her carotids.


5. Chronic right-sided leg pain. She could have occlusive vascular disease in her lower extremities. We will do the CT angiogram of that as well.


6. Ongoing tobacco abuse. I advised her not to smoke. She is not going to quit. She made that very clear to me.


7. History of lung cancer. Treated with radiation therapy. No evidence of metastatic disease.


8. Dizziness. Probably due to vascular disease. I do not think it is due to any significant arrhythmias. We will place a holter on her to be on the safe side, however.

At least she doesn't have kidney stones or the heartbreak of psoriasis. I'm thinking this little workup on this 80+ year-old patient is going to cost about $15,000+ or whatever Medicare will pay. Let's hope her kidneys hold up with all that iodinated contrast she's about to get.

Now you know how doctors think. Test every twinge, and if the test shows something, order more tests. I wonder why some still carry stethescopes.

JibJab's 2007 Year In Review..What More Can I Say?

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Voice Recognition and Value

Dr. Giles Boland has written an editorial about the value radiologists can provide with speech recognition (Dr. Boland prefers the more popular though less accurate term Voice Recognition). Dr. Boland is on the radiology staff of Mass General, and he is a member of RCG HealthCare Consulting, which provides "Complete IT & Management Consulting for Radiology Departments and Imaging Practices". From the RCG website, we find that Dr. Boland is:

Vice Chairman of Radiology, Massachusetts General Hospital, Dr. Boland’s areas of specialty include PACS, Teleradiology, Voice Recognition, RIS, and the enterprise digital solution to PACS and RIS integration. He has conducted aproximately 40 pesentations in over 15 countries on these topics. As a practicing radiologist, his nterests lie in Abdominal Imaging and Interventional Radiology. Dr. Boland is an Advisor to the World Health Organization, Geneva Switzerland and a reviewer for multiple scientific journals including New England Journal of Medicine, Radiographics, American Journal of Roentgenology and Journal of Intensive Care Medicine.

Those are impressive credentials. Dr. Boland's case for VRT is as follows:

Voice recognition technology cuts a swath across the process through which conventional preliminary findings metamorphose into a final report. Once a report is dictated into VRT, it is in fact a final, signed report (unless originally dictated by a radiology resident or fellow). By virtue of its electronic nature, such a report becomes available immediately across an institutional network, simultaneously to multiple caregivers. Consequently, final report turnaround times are typically drastically reduced. When VRT was introduced at the Department of Radiology at Massachusetts General Hospital in 1997, the final report turnaround time for staff dictated reports was reduced from 3 days to several hours almost immediately [11]. This efficiency was realized despite the fact that earlier VRT models were harder to use and had less efficient speech recognition software.

The implication is that the technology has improved a great deal; the closing paragraph in the editorial reads:

However, despite the real advantages to radiology customers of VRT, some radiologists would still rather promote an inferior transcription model, preferring instead to use traditional dictation methods, which delay their ability to generate final reports. Although radiologists' customers are looking for succinct, standardized, and timely final reports, some radiologists continue to use a system that their customers find less valuable. Rather than using existing state-of-the-art technology, radiologists should take an active role in convincing their peers to adopt VRT. If necessary, they should also lobby their organizations to provide the capital required to finance the transition, which generally yields a very favorable return on investment within the first year [11]. Radiologists can then rightly claim that they have been instrumental in adding significant value to their product, a major benefit to patient care and all stakeholders.

Note the derrogatory language. Those that have not embraced VRT/SR are using an inferior model. This raises some concerns. Whilst Dr. Boland has the background to know what he is talking about, the superior attitude is not particularly endearing. We have had the VR/SR debate on AuntMinnie ad nauseum, and the majority opinion amonst radiologists (NOT administrators, IT types, etc) is that it is not ready for primetime. Maybe Dr. Boland has access to more advanced software that actually works as advertised, which would make his analysis spot on. Unfortunately, the machinery that makes it out to the boonies doesn't seem to work well enough to justify the accolades. I think it is noteworthy that the JACR article contains no mention of Dr. Boland's association with RCG Consulting or the fact that RCG Consulting considers voice technology one of its areas of expertise. Perhaps it is simply understood that anyone on the Mass General Radiology staff is a part of RGC. I'm sure there is no conflict of interest here. Of course not.

I'm not so much of a Luddite that I don't appreciate what Dr. Boland is saying here. I just don't think the machinery is quite there yet. So, I'll stick with my inferior model for now, thank you.

'Twas A Month Before Christmas......A Hypothetical Bedtime Story

'Twas a month before Christmas, at RSNA,
All the vendors were tired; they'd been there all day.
The scanners were placed on the carpets with care,
In hopes that big customers soon would be there;

The techs were nestled all snug in their beds,
While big party hangovers messed with their heads;
The PACSMan with camera and me taking notes
Were on the Grand Concourse after ransoming coats,
When out on the floor there arose such a clatter,
I sprang over there to see what was the matter.
And to the exhibits I flew like a bee,
Tore right through the guards with my RFID,

The green glow of lights on white carpeted floor,
Gave a nice, eerie lustre to scanners galore,
But, what do my watering eyes then behold,
But a bright-green stretch limo with bumpers of gold
With a little old driver, who was packing some heat,
I knew in a moment this wasn't my treat.
More rapid than eagles his helpers they came,
And he whistled, and shouted, and called them by name;

"Now, Vito! now, Carlo! now, Marco and Vinnie!
On, Gino! on Louie! on, Fingers and Johnny!
To the top of the food court! the top of the wall!
Now dash away! dash away! dash away all!
Boys, grab Dr. Dalai and do it with haste,
We'll teach him to mess with us! No time to waste!"
So deep in the exhibit they took me, Dr. Dalai,
And all shook their heads at the depth of my folly.
I knew I was done for; there wasn't much question.
The pain in my chest wasn't just indigestion.

The booth then exploded with a thunderous roar,
As angry ex-customers took to the floor,
They wore plastic badges edged all in blue;
And most RFID's were torn up in two,
They came into the booth just like a great flood;
You could tell in their eyes, they were looking for blood.
Their droll little arms were all waving P.O.'s
Which they shredded all over the carpeted rows.
The stump of a pen they held tight in their fists,
One particular vendor was scratched off their lists;

The guys in the limo began looking pale,
They shook, and they quaked, and I knew they would bail.
My readers all came to my rescue that day
And I laughed when I realized I'd not soon decay,
They all winked as one, and we knew we'd prevail
Because nothing hurts like the loss of a sale;

The limo and driver and all of his minions,
Skulked out of the booth muttering "Gosh Darn opinions",
Removing his finger from inside of his nose,
And waving said finger, up the vent shaft they rose;
All over the North Hall and also the South
The news of our story came from every mouth.

Said the green-suited man as he entered the fog:
The Heck with you, Dalai, and Heck with your blog.

The Squawkie and the Cymbal...A Hypothetical Post About A Hypothetical Machine

In the vacuum of my once-productive mind, there occasionally forms some strange ideas. I wondered what might happen if one tried to combine Ultrasound and CT scanners to form an US/CT device. This idea could have some interesting consequences, and following is a fictional account of how this might play out in the marketplace... Note that the machines are not real, no one has one, and no one will ever get one.

Trying to stay at the leading edge of technology is difficult at best, and expensive to say the least. The hospitals down the road, across town, or on the other side of the country are always trying to one-up each other, buying the latest and greatest, usually to be leap-frogged by the next great development.

Here at my above-average hospital in a large town in the North, we have caught the bug to buy one of the new hybrid ultrasound/computed tomography scanners, the US/CT. This is really incredible technology, which will allow us, for example, to definitively diagnose renal lesions and declare them cystic or solid on the spot. The CT image helps orient the ultrasound and can provide depth and echogenicity adjustments.

As with most advanced products of this nature, there are several choices. Black and Decker produces a rather small and relatively compact unit called the Squawkie (UltraSOUND, noise, squawk, get it?). This is a very elegant machine, with a tiny x-ray tube mounted to the hand-held ultrasound transducer. An x-ray detector belt is placed around the patient, and both the CT and the U/S images are formed as the sonographer (wearing lead gloves) performs the exam.

Bosch, on the other hand, has their own version, called the Cymbal (Cymbals make noise like UltraSound, yes?), which, typical for European engineering, takes a battle-ship like approach, mating an automated U/S transducer on an articulated arm to a full-size CT scanner. There is a continuous flow of ultrasound gel through a port near the transducer face.

These two machines obviously represent rather diverse approaches to the problem. Which to choose? My inclination is to go with the Bosch, as I like their fuel injectors, and so I would assume their US/CT device is just as well made. But the Black and Decker folks have been very persuasive. They sent a number of articles outlining the dangers of too much CT radiation, which is kind of funny since they sell a lot of regular old CT's. But they very correctly point out that the minimalist CT approach found in the little Squawkie has less CT radiation than the full-CT of the Bosch. And there's the problem. The Squawkie's limited CT doesn't produce a great image, and no one expects it to do so given its limited radiation. Supposedly it's CT is good enough to enhance the U/S image, and some say it will work better for this purpose. BUT, to the guy looking at the study, a very important factor is the ability to match the U/S to the CT, and for that, a diagnostic quality CT is needed. Black and Decker points out that the patient has probably already had one on another machine, which may or may not be true. If they have, B&D suggests simply using the computer to match the U/S to the CT, but that doesn't always work well. Heck, even the example they have in their literature shows a pretty bad misregistration of part of the U/S relative to the CT. I don't trust that approach. But we all agree, I guess, that a diagnostic CT is needed somewhere along the line. And everyone who has a Squawkie, including the academic center in the hills north of us, says that it's CT images are, ummmmm, not diagnostic.

Bosch's approach with the Cymbal assumes that the diagnostic CT is such an important part of the study that it should be included with the U/S. So, with a little planning, the patient could have the U/S and the diagnostic CT all in one sitting, and eliminate the small but extra CT dose that he would have to have with the Squawkie. To me, that is the more logical way to do it. But that's just my opinion......

Decisions, decisions......

Dalai's Latest Phone

One of my older posts bashed Palm mercilessly, and you will still find this on my blog as Palm is probably used to this and isn't interesting in nagging me about it. I haven't had a Palm product since my old Tre0 600, and I haven't regretted the jump to Windows Mobile for a second.

I've been a little down lately, as you all know well, but nothing combats the blahs like buying a new toy. Since my old Blackjack was just over a year old, AT&T felt the need to tempt me with its new successor, the Blackjack II, and I succumbed. I'm really glad I did.

The Blackjack II, officially the Samsung SGH-i617, outdoes the older SGH-i607 in a few critical areas. First, the screen is marginally larger (about a millimeter or two in each dimension), but it is a bit brighter and sharper. The difference is quite noticeable. The Blackjack II has a great deal more on-board memory, 155MB as compared to only 55MB for the older version. That makes a huge difference in how one allocates memory space. My 2GB microSD card was easily transferred to the BJII, which is now capable of handling 4GB cards. No doubt I'll get one of those eventually. A larger standard battery means longer talk-time, and a faster processor means, well, faster processing and a bit peppier response overall.

One unfortunate change was made in the universal connector, which is how one charges the phone, connects to a computer, or plugs in headphones. It is unfortunate because I had spend a small fortune in extra chargers and headphone adapters (it works very well with Bose sound-cancelling headphones), and now I have to replace all of that. I take some consolation in the fact that the new connector (which is the same as found on Samsung's Helio phones, for some strange reason) is a little stubbier and sturdier, and has its top or front more clearly marked. I really wish Samsung had gone with a more universal mini-USB connector, which would have made my life easier. The stupid little plastic plug over the port is now chrome-plated, but still will likely break off before the rest of the phone wears out. The casing is now shiny black with chrome trim. It looks better than before, but attracts fingerprints like a magnet.

The BJII has Windows Mobile 6, with a few incremental improvements over WM5, most notably the addition of Office Mobile with limited versions of Word, Excel, and PowerPoint. There is now a GPS receiver using the SRiF Star III assisted GPS chipset. AT&T packages a trial of the TeleNav Software, which can cost $100/year to use. Fortunately, with this little tweak, you can get the GPS to work with Google Maps, which is free. Speaking of tweaks, changing the function of the right soft key in the home screen requires the use of a program such as Right-Tweaker, something that could be done with onboard software before. But, you can more easily assign shortcuts to letter keys than before. Keep in mind, this is still a Smartphone, not a Pocket PC, and it has no touch-screen. Coming from the older Blackjack, and an Audiovox PPC 6600 before that, and a Treo 600 before that, I find I really don't miss the touch screen at all.

The strangest conversion is that of the scrolling function. Previously, there was a Blackberry-like scroll-wheel on the right side of the unit. This has been removed. Instead, the D-pad controller on the front now rotates and can be used rather like the click-wheel on an iPod. I didn't believe at first that the wheel actually physically spins, but my son proved it to me by rotating it carefully with one finger whilst holding another finger steady on the wheel. It takes some getting used to, but in the end, I think it works as well as the side-mounted version. There seems to be no way to adjust the scrolling speed, however.

The bottom line: the BJ-II is a worthy successor to the BJ. There aren't any huge changes, but the improvement was adequate for me to justify the upgrade. But then, that usually isn't too difficult. Next stop, the iPhone II, due out next year...

The Wizard of OS

If you're here, you no doubt know about my little problem with the Big Company and so forth. I never, ever dreamed that this average radiologist from the South could cause such an uproar with a lil' ol' blog. I'm still surprised anyone even reads the darn thing at all! But, you do, and I have received a great deal of support via e-mail, AuntMinnie thread, and even the odd phone call.

We didn't have to "go here" as the kids say. So many other companies, among them Afga, AMICAS, Sectra, Emageon, Intelerad, etc. have used my comments to make their products at least a little bit better. I guess someone in this other company in question didn't think I had the potential to do that for them. Oh, well....

To those who have supported and continue to read my stuff, know that neither I or my rather amateurish but still lovable blog plan on going away anytime soon. To those who don't like my postings or have a problem with them, I only ask that you e-mail me or call me if you have questions or want to talk about it. You can also post a comment to the offending paragraph.

The way this whole scenario unfolded hurt me and my family deeply, and could have been diffused with a little dialogue. I've changed my blog postings before, and won't hesitate to do it again if I am wrong or if my comments hurt someone personally. That said, if your product sucks or I take a stance you don't like, please deal with me directly. I'm a man and I can take it. Just don't do an end around me where I have to explain my actions to others or worry about my livelihood or those of my partners being threated as happened here. As my friend the PACSMan pointed out, that is a Chicken Little way of dealing with it (although I think he changed the word little to a more "excretionary" term instead). I'm hoping that the legacy of this tempest in a teapot will be the establishment of better dialogue between all of us whose job it is to care for our patients in the best manner possible.

The PACSMan also sent me this (complete with pictures) which brought a smile to my face for the first time in several days, and has given me permission to share it with you all. I hope you enjoy it as much as I did....

Mike said, "Oy gevalt, what have you done my friend !!! Do you realize how much this whole story resembles the Wizard of Oz? It’s uncanny. Use this to explain what has happened to your blog site readers. They will fill in the blanks themselves…"

THE WIZARD OF OS

Average radiologist Dalai Lama lives an average life in an average town in the South with a hyperactive Jack Russell terrier named Blogger, along with Aunt Minnie and three colorful farm hands, Hunk, Zeke, and Hickory. One day their stern neighbor, Miss Imagination, is bitten by Dalai’s dog, Blogger. Dalai senses that Miss Imagination will try to do something dreadful, but his aunt and uncle, as well as the farmhands, are too busy with their work to listen. Dalai yearns for a better place in the song Over the Ether(net). Miss Imagination shows up and takes Blogger away to be destroyed, by order of the sheriff, over the impassioned protests of Aunt Minnie and Uncle Henry. Blogger escapes and returns to Dalai, who is momentarily elated but soon realizes Miss Imagination will return, and extract even greater revenge. He decides to take Blogger and disappear.

The Wicked Witch of the West

As they flee, Dalai and Blogger encounter Professor Marvel, a lovable but fake fortune teller who, out of concern for Dalai, tricks him into believing Aunt Minnie is ill so Dalai will not run away from home. Dalai rushes back to the farm but is knocked unconscious, inside the house, by a sudden South Carolina twister that has already forced his family into the storm cellar behind the house.

A confused Dalai awakens to discover the house has been caught up in the twister. Through the bedroom window, he sees a parade of people fly by. Then he sees Miss Imagination, also caught in the tornado, and pedaling her bicycle in midair, transformed into a witch. Moments later the twister drops the house, Dalai and Blogger over the rainbow and into OS. Glinda, the Good Witch of the North arrives and informs Dalai they are in Munchkinland. She tells Dalai he has killed the Wicked Witch of the East by “dropping a house" on her.

Encouraged by Glinda, the timid Munchkins (played by representatives of the smaller PACS companies) come out of hiding and celebrate the demise of the witch singing "Ding, Dong, The Witch Is Dead" among other cheerful songs until her identical twin sister, the Wicked Witch of the West, appears to claim the powerful ruby keyboard. Glinda magically transports the keyboard into Dalai's hands and reminds the witch her power is ineffectual in Munchkinland. The witch vows revenge on Dalai and leaves the same way she arrived, in a blaze of fire and smoke. Glinda tells Dalai, who is anxious to return home, that the only way to get back to South Carolina is to ask the mysterious Wizard of OS in the Emerald City for help. Glinda advises Dalai to never lose the keyboard and to "follow the yellow brick road" to reach the Emerald City.

On his way Dalai befriends a Scarecrow with no PACS, a Tin Woodman with malfunctioning speech recognition, and a Cowardly Lion with no PET/CT. The three decide to accompany Dalai to the Wizard in hopes of obtaining their desires. Along the way they are plagued by a forest of angry IT personnel and several failed attempts by the witch to stop them. While they arrive at the Emerald City, they are interrupted by the Wicked Witch, who flies across the sky, writing, "Surrender Dalai". The group talks to the Wizard of OS, who says that he will consider granting their wishes if they can bring him the broom of the Wicked Witch. The group then departs for the witch's castle.


Dalai comforts the Cowardly Lion

On their way to the witch's castle, they are attacked by flying monkeys, who carry Dalai and Blogger away and deliver him to the witch, who demands the ruby keyboard. When Dalai refuses, the witch tries to remove it but is prevented by a shower of sparks. She realizes the keyboard cannot be hers as long as Dalai is alive and plots on how to destroy him without damaging the keyboard's spell. As the Witch is considering on how to kill Dalai, Blogger takes the opportunity to take escape from the Witch’s grasp with Dalai crying, "Run, Blogger, run!” Outraged, the Witch screams at the Monkey, "Catch him, you fool!" but Blogger manages to escape, much to Dalai’s relief. The Witch, furious, snarls to Dalai, "Which is more than what you will, my little pretty!!!" and runs over to a large hourglass filled with red-blood sand and turns it over, gleefully telling Dalai he will die when the hourglass empties. She puts the hourglass down and runs out of the chamber, locking Dalai inside. Sobbing, Dalai calls for Aunt Minnie, saying he is frightened. Aunt Minnie appears, and Dalai tries to tell her that he is trying to get home. The witch appears, mocking and laughing at Dalai. Meanwhile, Blogger manages to find the lion, the scarecrow, and the Tin Man and lead them to the castle where Dalai is awaiting his demise. Once inside they are barely able to free Dalai and attempt an escape. The witch and her Winkie soldiers corner the group on a parapet, where the witch sets the Scarecrow on fire. To douse the flames, Dalai throws water on them, and accidentally splashes water on the horrified witch, causing her to melt. To the group's surprise, the soldiers are delighted. Their captain gives Dalai the broomstick to thank him for their liberation from the witch. Upon their return, the wizard tells Dalai and his companions, "Go away and come back tomorrow!!" Thanks to Blogger, though, they discover the wizard is not really a wizard at all, just a man behind a curtain. They are outraged at the deception, but the wizard solves their wishes through common sense and a little double talk rather than magic.

The wizard explains that he too was born in South Carolina and his presence in OS was the result of an escaped hot air balloon. He promises to take Dalai home in the same balloon after leaving the Scarecrow, Tin Woodman and Lion in charge of Emerald City. Just before take off, Blogger jumps out of the balloon's basket after a cat. Dalai jumps out to catch Blogger and the wizard, unable to control the balloon, leaves without him. He is sadly resigned to spend the rest of his life in OS until Glinda appears and tells him he can use the ruby keyboard to return home with Blogger. Glinda explains she did not tell Dalai at first because she needed to learn "if you can't find your heart's desire in your own backyard, then you never really lost it to begin with." Dalai and Blogger say goodbye to their friends, and Dalai follows Glinda's instructions to "hit Ctrl-Alt-Delete and repeat the words, 'There's no place like home'." He awakens in his bedroom in South Carolina surrounded by family and friends and tells them of his journey. Everyone laughs and tells him it was all a bad dream. A happy Dalai, still convinced the journey was real, hugs Blogger and says, "There's no place like home."

When Dalai wakes up from his trip to OS, the issue with Blogger and Miss Imagination appears unresolved and are left to the audience to interpret.

THE END

Dalai's Unpleasantness

The AuntMinnie thread concerning my "kinder and gentler" blog has me really amazed. With one minor exception, the posts have been very supportive. My friend Mike Cannavo, the One and Only PACSMan has worked the story into a wonderful allegory, which I will post in the next day or two. In the meantime, I'll duplicate my last word on the subject in the AM thread:

Well.... This is all a bit stunning.

The facts of this situation are essentially as the PACSMan has related them. After seeking legal counsel, and being told that fighting a large company was impossible, I removed any and all posts that the particular large company or clinic might find offensive. I did exactly what I was asked to do. When asked by regular readers of my blog why I had done so, I answered honestly. For my own protection, I must point out that the comments above are a spontaneous outpouring, and were not commissioned or requested by me. Frankly, they will probably get me deeper into trouble. But there's not much I can do about that.

This thread indicates a number of things to me. First, I have more friends and supporters among my readers than I might have guessed. My blog continues to get upwards of 200 hits per day, even in its "kinder and gentler" form. Second, there is a great desire for user-based information on the topics I write about. There is little if any other such coverage. Was I a little hard on a certain company? Yes, but that was borne of my frustration with their interface as well as their sales techniques. I meant no personal offense, and in fact, my posts were always directed to the company in general. I do wish that this particular company had done what Agfa has been doing for quite a while now, send their designers and engineers to sit beside me and my partners and see exactly how we work, and how their product could facilitate our workflow. That would have been a win-win situation. Third, there seems to be a tremendous amount of animosity in the radiology community toward this particular vendor. They know it, and what you see on this thread is just the tip of the iceberg. Perhaps this has never been said aloud before, and it's not something that becomes apparent in a focus group or a survey. That needs to be understood and dealt with, and not with a sledge-hammer.

It's time we all step back, vendors and buyers, salespeople, engineers, designers, techs, and even radiologists, and remember why we are all here: The goal is to provide absolutely the finest possible care for our PATIENTS. There has to be a new paradigm of involving everyone in every aspect of this process. To squabble and suppress does nothing good for those who need our services.

I trained as an engineer, and sometimes those principles can be applied to life. In electrical engineering, there is something called negative feedback. When one amplifies a signal, a small percentage of the output must be used to reduce the input. Othewise, the amplifier will continue to elevate its output until it melts. Similarly, in real life, a tincture of negative feedback keeps us grounded (not in the electrical sense this time), and helps us function properly. To quote from the late philosopher Jacob Bronowski, exerpted from his series, The Ascent of Man:

Science is a very human form of knowledge. We are always at the brink of the known; we always feel forward for what is to be hoped. Every judgment in science stands on the edge of error and is personal. Science is a tribute to what we can know although we are fallible. In the end, the words were said by Oliver Cromwell: "I beseech you in the bowels of Christ: Think it possible you may be mistaken."

All of us engineers should appreciate that.

Good night, everyone.

Stupid Things People Do For Money

Here is a light, entertaining post about a foolish fellow in my own state of South Carolina who tried to use a fake $1,000,000 bill "to open an account in an Aiken, S.C, bank. Alexander D. Smith, 31, was charged with disorderly conduct and two counts of forgery..." Photo is from the Aiken County Sheriff's office via FoxNews.com.



I never cease to be amazed at the level of stupidity and deception folks exhibit in their attempts to extract the maximum amount of money out of a particular situation.

The MILF Sale

In the "spirit" of kinder, gentler, non-confrontational, and non-controversial postings, here is some light entertainment from Spirit Airlines, offering their "M.I.L.F" Sale:

The MILF Sale

Many Islands, Low Fares - From $9* Each Way
Now is the perfect time to book that trip to paradise. Spirit is offering great, low fares to many exotic destinations at incredibly low fares - from only $9* each way! But hurry, the Many Islands Low Fares Sale ends Monday night, December 3, 2007 at 11:59 PM ET! Please see the full list of destinations below. All fares are each way, based on a roundtrip purchase and taxes, fees & restrictions apply.

Time to go back to the islands, Mon. I wonder if they have heard of the "other" definition of M.I.L.F.?

I do hope I haven't offended Spirit, or lost them any sales with this amusing, light-hearted posting....

Addendum

It seems that Spirit must have heard about that other meaning.... It seems rather ironic that they chose the "Mom" theme....

The Mom and Apple Pie Sale

With Fares From $9* Each Way
What's more good and wholesome than mom and apple pie? The only thing we could think of was a great sale with low fares to your favorite destinations - from only $9* each way. Now is the perfect time to book that trip to paradise. But hurry, mom, the apple pie and this great sale will be gone by Monday night, December 10, 2007 at 11:59 PM ET! Please see the full list of destinations below. All fares are each way, based on a roundtrip purchase and taxes, fees & restrictions apply.

Now, that's Spirit!